The Cleveland Browns have been in the news this week, and not because of newfound success on the gridiron. While sports is not among my highest priorities, I have developed increasing interest over the years since professional sports is religion to so many here in Cleveland and in Ohio. Cleveland sports teams all enjoy great success, provided that success is not defined by victories. It’s not if you win or lose but how… I watched the Cleveland Browns compete against the Pittsburgh Steelers two Thursdays ago. I cringed as I witnessed our young quarterback, Colt McCoy, take a blow to the head that could have landed the perpetrator a 10 year prison sentence had this act occurred on the street. I wasn’t worried that McCoy would have to miss the rest of the game. I feared that he might have to miss the rest of his life. Violence sells tickets.

If an activity requires a participant to don a helmet and a coat of armor, then clearly it is an unwise activity for a human to engage in.

McCoy was taken off the field and reentered the arena 2 plays later, after an exhaustive evaluation that was completed in about 100 seconds. Since everything in sports and medicine is now measured, we know that McCoy was sidelined for a total of Read more »

National Impact Database

Adult Football Helmet Ratings – May 2011

A total of 10 adult football helmet models were evaluated using the STAR evaluation system for May 2011 release. All 10 are publicly available at the time of publication. Helmets with lower STAR values provide a reduction in concussion risk compared to helmets with higher STAR values. Based on this, the best overall rating of ‘5 Stars’ has the lowest STAR value. Group rankings are differentiated by statistical significance.

If you’re in the market to buy a loved one a football helmet, or just curious, go and have a look. It doesn’t take long, there are only 10 helmets on the list. Go to the list.

Anyone who’s ever watched football, the American variety, knows how rough of a sport it can be. With 22 fast-moving players (some weighing as much as 350 pounds) scrambling and tackling for possession of the pigskin, injuries are inevitable.

One of the scariest injuries a football player can get is a concussion. With its commonly insidious onset, concussions of the brain are often difficult to diagnose, or immediately treat to avoid long-term consequences.

The National Football League (NFL) has announced that they will be launching a pilot program next season in which accelerometers will be placed in players’ mouthpieces, earpieces, and helmets to analyze how blows to the head relate to the effects and severity of concussions and other traumatic brain injuries. The data could potentially help team doctors diagnose the severity of a concussion within a few minutes. Collected long-term from groups of players, the impact data could help coaches and doctors determine how players get injured and the possible effects of such injuries. Such data could also help engineers design a better football helmet.

As long as the game of football continues to be played, concussions will be pretty much impossible to avoid. However, changing technology and increasing knowledge of traumatic brain injury will hopefully only make football a safer, more enjoyable sport.

1. Health care reform

How could the health care reform legislation that President Barack Obama signed into law on March 23, 2010, not be the #1 story of the year? Whether you are for or against it, the Patient Protection and Affordable Care Act is nothing if not ambitious, and if implemented, it will fundamentally alter how American health care is financed and perhaps delivered. The law is designed to patch holes in the health insurance system and extend coverage to 32 million Americans by 2019 while also reining in health care spending, which now accounts for more than 17% of the country’s gross domestic product. The biggest changes aren’t scheduled to occur until 2014, when most people will be required to have health insurance or pay a penalty (the so-called individual mandate) and when state-level health insurance exchanges should be in place. The Medicaid program is also scheduled to be expanded that year so that it covers more people, and subsidized insurance will be available through the exchanges for people in lower- and middle-income brackets. But plenty is happening before 2014. The 1,000-page law contains hundreds of provisions, and they’re being rolled out in phases. This year, for example, the law created high-risk pools for people with pre-existing conditions, required health plans to extend coverage to adult children up to age 26, and imposed a 10% tax on indoor tanning salons. Next year, about 20 different provisions are scheduled to take effect, including the elimination of copayments for many preventive services for Medicare enrollees, the imposition of limits on non-medical spending by health plans, and the creation of a voluntary insurance that will help pay for home health care and other long-term care services received outside a nursing home. Getting a handle on the complicated law is difficult. If you’re looking for a short course, the Kaiser Family Foundation has created an excellent timeline of the law’s implementation (we depended on it for this post) and a short (nine minutes) animated video that’s one of the best (and most amusing) overviews available. The big question now is whether the sweeping health care law can survive various legal and political challenges. In December, a federal judge in Virginia ruled that the individual mandate was unconstitutional. Meanwhile, congressional Republicans have vowed to thwart the legislation, and if the party were to win the White House and control of the Senate in the 2012 election, Republicans would be in a position to follow through on their threats to repeal it.

2. Smartphones, medical apps, and remote monitoring

Smartphones and tablet computers are making it easier to get health care information, advice, and reminders on an anywhere-and-anytime basis. Hundreds of health and medical apps for smartphones like the iPhone became available this year. Some are just for fun. Others provide useful information (calorie counters, first aid and CPR instructions) or perform calculations. Even the federal government is getting into the act: the app store it opened this summer has several free health-related apps, including one called My Dietary Supplements for keeping track of vitamins and supplements and another one from the Environmental Protection Agency that allows you to check the UV index and air quality wherever you are. Smartphones are also being used with at-home monitoring devices; for example, glucose meters have been developed that send blood sugar readings wirelessly to an app on a smartphone. The number of doctors using apps and mobile devices is increasing, a trend that is likely to accelerate as electronic health records become more common. Check out iMedicalapps if you want to see the apps your doctor might be using or talking about. It has become a popular Web site for commentary and critiques of medical apps for doctors and medical students. Meanwhile, the FDA is wrestling with the issue of how tightly it should regulate medical apps. Some adverse events resulting from programming errors have been reported to the agency. Medical apps are part of a larger “e-health” trend toward delivering health care reminders and advice remotely with the help of computers and phones of all types. These phone services are being used in combination with increasingly sophisticated at-home monitoring devices. Research results have been mixed. Simple, low-cost text messages have been shown to be effective in getting people wear sunscreen. But one study published this year found that regular telephone contact and at-home monitoring of heart failure patients had no effect on hospitalizations of death from any cause over a six-month period. Another study found that remote monitoring did lower hospital readmission rates among heart failure patients, although the difference between remote monitoring and regular care didn’t reach statistical significance. Read more »

FREDERICK, Md. — The Army says it has discovered a simple blood test that can diagnose mild traumatic brain damage [TBI] or concussion, a hard-to-detect injury that can affect young athletes, infants with “shaken baby syndrome” and combat troops.

“This is huge,” said Gen. Peter Chiarelli, the Army vice chief of staff.

Yes, it is, if it pans out. There’s so little actual information in this that it’s hard to get excited about it, but let’s say they’ve isolated a “brain injury” protein.

First, it would have uses outside traumatic brain injury (TBI), though that in and of itself might be useful. I don’t want to poo-pooh this test for TBI, but there are already rules for returning to contact sports (and combat has to be the ultimate in contact activities), so what’s the purpose here? (I forsee more Purple Hearts, which is fine.)

Stroke? TIA? Seizure? Pseudotumor cerebri, as a strain indicator? What if this is the test that allows us to diagnose meningitis without doing lumbar punctures? I’m all in on that front. Let’s hope this pans out, for all our sakes.

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